Optimizing Your Return to Exercise After Brain Injury:
Safe Strategies, Recovery Tips, and Exercise Recommendations
Before my brain injury, I was in great shape, ate well, and trained hard.
After my car crash, I expected to recover fast and get back to my martial arts training. But I found out the hard way that was not going to be the case.
Whenever I tried performing a kata, I ended up out of breath, with my heart racing and my head hurting. I got confused and forgot my karate moves and their names. Sometimes, when I tried to move my foot forward, it would go backward instead. The harder I pushed, the worse my symptoms got.
Looking back, I believe my efforts to exercise despite my symptoms led to an unnecessarily prolonged recovery.
I later learned that struggling with exercise is a common symptom of brain injury and that brain trauma can affect the autonomic nervous system and your tolerance of exercise.
Before Starting Exercise:
At the start of your recovery, focus on your rehabilitation therapy exercises first. These are meant to help you heal, so they should come before any other exercise or sports.
Prior to starting exercise, discuss your plans with your doctors, physical therapist, occupational therapist, neurotherapist, and behavioral optometrist. Let these specialists assess whether it is safe for you to return to exercise or a sport, then develop a personalized return-to-activity plan.
Outside of Anchorage, Alaska. It’s so beautiful.
Ask your doctor if you need these tests:
Before you exercise, it’s important to check for problems with your autonomic nervous system.
Your doctor can check your orthostatic vital signs. This test measures your blood pressure and heart rate as you move from lying down to sitting, then to standing, with a five-minute wait in each position before measuring your vital signs. (1)
Another helpful test is the tilt-table test, which checks for problems with your autonomic system after a head injury. It can help find post-concussive orthostatic tachycardia (OT) and postural orthostatic tachycardia syndrome (POTS). (2) (3) Both conditions have similar symptoms of headaches, fatigue, lightheadedness, brain fog, and poor exercise tolerance. If not treated, they can make recovery longer and make it harder to return to exercise and work.
The Buffalo Concussion Treadmill Test is also useful. It helps figure out how much exercise you can handle and sets safe limits for your return to activity, based on your symptoms and heart rate.
Safety First
At the start of your recovery, avoid pushing yourself until you’re exhausted or in pain. Learn from my experience—stay active, but make sure your exercise is safe and within your limits.
Try to be active most days. Remember, you don’t need a gym to exercise. There are many activities to choose from, so pick something you enjoy and find rewarding.
I often tell my patients that exercise should be rejuvenating to the body and mind and have a relaxing effect on the muscles. If you’re exhausted and have discomfort after exercising, then you know you have pushed yourself too hard.
I suggest staying away from high-impact sports and activities that could lead to another head injury, like snowboarding, skiing, and mountain biking. For me, risking another brain injury isn’t worth it, since each brain injury is cumulative. Meaning each time you hit your head, it will take longer for you to recover. For this reason, I stopped snowboarding and downhill skiing.
You should avoid activities that require rapid response times. After a brain injury, it’s common to move slowly, feel off-balance, and have a slower reaction time. So, you may want to skip playing sports like tennis, basketball, fencing, soccer, and football until your reaction time is back up to speed.
Instead, try activities like walking, swimming, dancing, gentle or restorative yoga, chair yoga, chair exercise, chair Tai Chi, hiking, standing Tai Chi, or gardening. For me, I found walking and chair yoga were great ways to start after my head injury.
Whatever you choose, keep moving to help your body and brain stay healthy. Pick one or more activities you will enjoy throughout the week. Stay active and safe.
If you struggle to return to exercise or your brain injury symptoms worsen, let your doctor and therapist know so they can help you get active again.
If you look towards the back of the picture, you will see a glacier.
Start Slow and Gentle
Your return to exercise will be as unique as your recovery. Some people get back to activity quickly, while others, like me, find it’s a longer journey.
If you’re ready, start an exercise routine slowly and increase your effort as you get stronger. Pay attention to your symptoms—if they get worse, ease up on intensity or duration, so you stay below the level that triggers them. If you can exercise for 2-3 weeks without symptoms getting worse, you can try pushing your limits a bit more. I monitored my own progress in my journal and in my calendar by noting the exercise I did, the duration, and how I felt afterward.
I found a good way to start is with something gentle, like walking outside for 10 minutes a day, two or three times a week. Every 2 weeks, I would increase my walking duration and the number of days I walked each week. If you have trouble with balance, ask your neurotherapist if recreational walking sticks might help. I found recreational walking sticks helped when I was walking on uneven hiking trails.
Getting back to an active life means finding a balance between your daily energy, managing your symptoms, and exercising. You’ll need to avoid getting stuck in a rut, but also be careful not to push yourself too hard.
I hope that you will be back to enjoying an active life soon.
Take care, get better, get stronger,
Kelly Tuttle
Brain-Loving Advocate
P.S. As a brain injury survivor, I understand the challenges of reintegration into the workforce.
If you’re also a survivor looking to return to work, please visit my website for my online program:Return to Work and Life After a Brain Injury.
You can also find my book, After the Crash: How to Keep Your Job, Stay in School, and Live Life After a Brain Injury, and additional resources.
My book, After the Crash, is also on Audible.
My book, After the Crash: How to Keep Your Job, Stay in School, and Live Life After a Brain Injury, can be found on Amazon or at your favorite independent bookstore
I created a journal just for you! Check out My Brain Injury Recovery Journal
My eBook, Getting Back Behind the Wheel
Please check out my YouTube channel.
My Podcast: The Mindful Return: From Brain Injury to Back to Work
Additional Resources: